Day Camp Waiver Form

Name of the Child*

First NameLast Name
Child's Birthday

MonthDayYear
Date
Name of the Parent/Guardian*

First NameLast Name
Parent/Guardian's Phone Number
Format: (000) 000-0000.
Emergency Contact #1 (after parent)

First NamePhone Number
Emergency Contact #2 (optional)

First NamePhone Number
Please describe any behavioral concerns, allergies or special needs we need to be aware of:
Yes, I give permissionNo, I do not give permission
Person(s), besides myself, with permission to collect my child from Inspired Tots.

Person #1Person #2
Statement of Consent & Waiver

I hereby agree and declare that I am the legal parentguardian of the above-named child and hereby consent to the child's participation in the activities that are described to me in registration process. I understand that activities of the kind described may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

I, the parent/guardian, hereby agree and declare that I have carefully read and understand the scope of the camp activities and I consent to the participation of the above-named child to these activities.

Any type of injury that may occur to the child without the fault of the camp management and activity supervisors, the camp management cannot be held responsible for any harm that may occur to the child without the fault of the camp management and activity supervisors.
*NEW* Measels Information

While not legislativly required, it is strongly recommended that all campers have up to date Measels vaccines. All staff at Inspired Tots have their MMR vacccines.

By signing below you agree to allow Inspired Tots to share contact information and attendance records to the Sudbury Public Health Unit in the event of a case of measels in our studio.

As always, campers are not permitted to attend Inspired Tots if they have a fever or contagious symptoms.
Parent/Guardian Signature
Day Camp Registration Form

Form must be completed for EACH child attending a camp. Registration form must be updated every 6 months.
Should be Empty:

Day Camp Registration Form